The U.S. Department of Health and Human Services announced sweeping changes to the pediatric vaccine schedule on Monday, sharply cutting the number of diseases U.S. children will be regularly immunized against.

Under the new guidelines, the U.S. still recommends that all children be vaccinated against measles, mumps, rubella, polio, pertussis, tetanus, diphtheria, Haemophilus influenzae type B (Hib), pneumococcal disease, human papillomavirus (HPV) and varicella, better known as chickenpox.

Vaccines for all other diseases will now fall into one of two categories: recommended only for specific high-risk groups, or available through "shared clinical decision-making" — the administration's preferred term for "optional."

These include immunizations for hepatitis A and B, rotavirus, respiratory syncytial virus (RSV), bacterial meningitis, influenza and COVID-19. All these shots were previously recommended for all children.

Insurance companies will still be required to fully cover all childhood vaccines on the CDC schedule, including those now designated as optional, according to the Department of Health and Human Services.

Health Secretary Robert F. Kennedy Jr., a longtime vaccine critic, said in a statement that the new schedule "protects children, respects families, and rebuilds trust in public health."

But pediatricians and public health officials widely condemned the shift, saying that it would lead to more uncertainty for patients and a resurgence of diseases that had been under control.

"The decision to weaken the childhood immunization schedule is misguided and dangerous," said Dr. René Bravo, a pediatrician and president of the California Medical Assn. "Today's decision undermines decades of evidence-based public health policy and sends a deeply confusing message to families at a time when vaccine confidence is already under strain."

The American Academy of Pediatrics condemned the changes as "dangerous and unnecessary," and said that it will continue to publish its own schedule of recommended immunizations. In September, California, Oregon, Washington and Hawaii announced that those four states would follow an independent immunization schedule based on recommendations from the AAP and other medical groups.

The federal changes have been anticipated since December, when President Trump signed a presidential memorandum directing the health department to update the pediatric vaccine schedule "to align with such scientific evidence and best practices from peer, developed countries."

The new U.S. vaccination guidelines are much closer to those of Denmark, which routinely vaccinates its children against only 10 diseases.

As doctors and public health experts have pointed out, Denmark also has a robust system of government-funded universal health care, a smaller and more homogenous population, and a different disease burden.

"The vaccines that are recommended in any particular country reflect the diseases that are prevalent in that country," said Dr. Kelly Gebo, dean of the Milken Institute School of Public Health at George Washington University. "Just because one country has a vaccine schedule that is perfectly reasonable for that country, it may not be at all reasonable" elsewhere.

Almost every pregnant woman in Denmark is screened for hepatitis B, for example. In the U.S., less than 85% of pregnant women are screened for the disease.

Instead, the U.S. has relied on universal vaccination to protect children whose mothers don't receive adequate care during pregnancy. Hepatitis B has been nearly eliminated in the U.S. since the vaccine was introduced in 1991. Last month, a panel of Kennedy appointees voted to drop the CDC's decades-old recommendation that all newborns be vaccinated against the disease at birth.

"Viruses and bacteria that were under control are being set free on our most vulnerable," said Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health. "It may take one or two years for the tragic consequences to become clear, but this is like asking farmers in North Dakota to grow pineapples. It won't work and can't end well."

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